{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T22:10:51Z","timestamp":1780438251090,"version":"3.54.1"},"reference-count":17,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,25]],"date-time":"2020-11-25T00:00:00Z","timestamp":1606262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>When antibiotic laden bone cement is used to manage periprosthetic joint infection (PJI), failure still occurs with its use in up to 30% of cases. Therefore, we designed an in vitro study to assess the bactericidal effect of <jats:italic>N<\/jats:italic>\u2010acetylcysteine (NAC), an antibacterial adjuvant, in cement against planktonic and biofilm forms of common PJI pathogens. NAC (10%, 20%, 30%, 40%, and 50% w\/v) added to polymethyl methacrylate (PMMA) and incubated in broth at 36\u00b0C. PMMA\u2010alone and\/or culture bacteria alone were used as a negative control. Aliquots of cement elution from each group were taken at 1\u2009day and 1\u2009week and then were investigated for antimicrobial efficacy against the planktonic\u2010form and the biofilm\u2010form of <jats:italic>Staphylococcus aureus<\/jats:italic> and <jats:italic>Escherichia coli<\/jats:italic>. The primary outcome was the residual colony\u2010forming unit count. The cytotoxicity and mechanical properties of the NAC\u2013PMMA cement\u2010blocks were also assessed. NAC\u2013PMMA efficacy against the planktonic bacteria was demonstrated at a minimum of 30% at Day 1 and a minimum of 20% at 1\u2009week after (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). NAC\u2013PMMA cement was effective against biofilm at a minimum of 30% of NAC at 1\u2009day and 1\u2009week of cement immersion (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). The PMMA alone group was identified as having the highest cytotoxicity (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). NAC decreased the stiffness (<jats:italic>p<\/jats:italic>\u2009=\u2009.004) and maximum load breaking point of the cement (<jats:italic>p<\/jats:italic>\u2009=\u2009.029). NAC is an effective and biocompatible adjuvant to PMMA in terms of antibacterial activity against <jats:italic>Staphylococcus aureus<\/jats:italic> and <jats:italic>Escherichia coli<\/jats:italic>. The broad antibacterial spectrum of NAC, its low expense, and minimal cytotoxicity makes it an ideal agent for addition to PMMA cement.<\/jats:p>","DOI":"10.1002\/jor.24910","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T08:33:11Z","timestamp":1605169991000},"page":"356-364","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["<i>N<\/i>\u2010acetylcysteine use as an adjuvant to bone cement to fight periprosthetic joint infections: A preliminary in vitro efficacy and biocompatibility study"],"prefix":"10.1002","volume":"39","author":[{"given":"Kamolsak","family":"Sukhonthamarn","sequence":"first","affiliation":[{"name":"Rothman Orthopaedic Institute  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeongeun","family":"Cho","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0933-6806","authenticated-orcid":false,"given":"Emanuele","family":"Chisari","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karan","family":"Goswami","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William V.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javad","family":"Parvizi","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,25]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.09.027"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.09.028"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24616"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dku254"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.01100"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.02.035"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/2835787"},{"issue":"19","key":"e_1_2_6_9_1","first-page":"2942","article-title":"N\u2010acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review","volume":"18","author":"Dinicola S","year":"2014","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"e_1_2_6_10_1","doi-asserted-by":"crossref","unstructured":"F04 Committee. Specification for Acrylic Bone Cement. ASTM International; n.d.https:\/\/doi.org\/10.1520\/F0451-16","DOI":"10.1520\/F0451-16"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.5301\/ijao.5000135"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2011.10.004"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-10-140"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/sca.21326"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.micpath.2017.02.030"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjm.2017.04.003"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2008.07.021"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biomaterials.2009.02.043"}],"container-title":["Journal of Orthopaedic Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jor.24910","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jor.24910","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jor.24910","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,3]],"date-time":"2023-09-03T13:14:04Z","timestamp":1693746844000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jor.24910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,25]]},"references-count":17,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1002\/jor.24910"],"URL":"https:\/\/doi.org\/10.1002\/jor.24910","archive":["Portico"],"relation":{},"ISSN":["0736-0266","1554-527X"],"issn-type":[{"value":"0736-0266","type":"print"},{"value":"1554-527X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,25]]},"assertion":[{"value":"2020-08-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}